HomeMy WebLinkAboutMortgage_Deisher^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION OC 1 � ZO1�
:• Sfate Form 43709 (R11 / 6-09)
�' ,�,� � Presaibetl by OeparUnetd of Local Ga/ernmettl Fitance
C.�. �
�lSTRUCTIONS: F� � ,
!o be filed in person or by maii with the CounryAuditor or Counry Recorder of the counry where the pmperty is located.
Fi7ng Dates: 1 J Real Properfy. Must file durirg the year fo� which the deduction is soughL GIBSON ���Q����
2) Mo6de / Manu/adured Homes rrot assessed as Real Prtiperty Must fi7e dunng the twelve (72) months
before March 37 of each year the deducfion is soughG Counry Recorder
See reverse side !or additmnal inst/uUions and qualifications.
MWcam(owrreroroonvart6vye�-segdesnictionsmseverseside) . .
ed raqie af real P�Y as of
1, qrmrt yYar
If no. what fs ha / her erarl
If n2me on
� �
KeyrumEer
�—�n � f "W � .f �
Mwtgage / Conhac['cWebtetlness unpaid a
March 7, airtem year
bebw
mntraa sever �
L5l
or mntrad seAer (num6r� end sbee4 GN. state.
Name of atsignea w oNer owner rn
AOCress ot astignee (number antl snee4 �Y. slste, antl Z/P code)
Does applipnt wm pmperty in any oNer
munry in Indiana? ❑ Yes I
oeaucea, aawa'� m mc zma,m oe
20 _ 20
Siaralure o( CounN AuEitw
I If yes. what counl/�
No
�a��
20 20
NTaI Tari�g Dist
20
Record m�mber
��
othe� Ihan spouse, indrcate with wtam
rant Ne sde
�itade owrwf?
Yes ❑ No
Is the property in question: Mnualty Assessetl
❑ Real Roperty ❑ Armually Assessed
—_ _ . —�_�
Dra�rer i\'
o...ao��........ -
Card NO. ..
.. � ��.�, .. . �
� �U a/ �� U. (jl� • ... _
rS'�
Date (monfh. daY. l'Qe�
20
I/ We certify unCU Ne penalty of perjury that the above arW foregoing infortnaUon is true and cortecl arW tha� the applkant is a resident of IrWiana aM
v.mer I contract buyer of the aForementioned properry on date application is filed.
nunu�e r w�e�s h� namel / _ Date (rtmtli, daY. Y��
ana sbaet tlry,
� ,6 KJ � (�<
auNa¢eE Ey dWy esecutetl
person (numberarM sbeet, dfy. sYdte, aM ZIP tode)
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